Fellowship - ENT/MF/Dent/ECT

Question 1

An 82-year-old patient is booked for excision of a floor of mouth squamous cell carcinoma and neck dissection, with radial forearm free flap reconstruction. Discuss the issues relevant to the intraoperative anaesthetic management for this procedure

Question 2

A 30-year-old patient is scheduled for laser resection of a subglottic mass to relieve mild stridor. Justify your intraoperative anaesthetic management of this case.

Question 3

What are the issues associated with jet ventilation?

Question 4

Discuss your considerations when anaesthetising a patient for functional endoscopic sinus surgery.

Question 5

A patient presents for a microlaryngoscopy and laser of a 5 mm nodule on his left vocal cord. (a) Outline the risks associated with the use of lasers in airway surgery. (50%) (b) Discuss the precautions that should be taken to manage these. (50%)

Question 6

Discuss the key areas of concern in your preoperative assessment of a patient for excision of a large tonsillar mass.

Question 7

“A 35-year-old female is booked for thyroidectomy. Her blood results are as follows.Thyroid stimulating hormone (TSH, thyrotropin) 0.1 (N 0.3 – 3 mIU/l)Total Thyroxine (Total T4) 20 (N 4 – 11 μg/dl)Free Thyroxine (Free T4) 4 (N 0.7 – 1.8 ng/dl)
Free Tri-iodothyronine (Free T3) 120 (N 60 – 175 ng/dl)a. Interpret the thyroid function tests (10%)b. Justify when you would proceed to thyroidectomy in this patient (50%)c. What is the management of an intraoperative thyrotoxic crisis? (40%)”

Question 8

A young adult male is assaulted and sustains a maxillary fracture. He is scheduled for an open reduction and internal fixation (ORIF) of the maxillary fracture on the emergency list. Outline the relevant anaesthetic considerations.

Question 9

Justify your choice and dosing of drugs when providing anaesthesia for electroconvulsive therapy (ECT)

Question 10

Describe the physiological responses to electroconvulsive therapy (ECT). (50%) Discuss how these affect your anaesthetic management of a patient undergoing ECT. (50%)

Question 11

“A 68-year-old man in hospital awaiting definitive surgery for a supraglottic squamous cell carcinoma of the larynx has worsening stridor at rest.
(a) How might his symptoms be improved in the preoperative period? (30%)
(b) Describe your evaluation of his airway and how this will influence your intraoperative airway management plan (70%)”

Question 12

Describe your management of a patient who has had a total thyroidectomy who develops respiratory distress in the recovery room.

Question 13

An 18yr old, otherwise healthy female, is to have 2 impacted wisdom teeth surgically removed as a day stay patient. Describe and justify features of your anaesthetic technique that may help prevent the common postoperative problems you would anticipate in this patient.

Question 14

How can recurrent laryngeal nerve function be assessed in the postoperative period?

Question 15

Discuss the issues specific to GA for myringoplasty

Question 16

A 55 yo adult is to have nasal polypectomy under general anaesthesia. The patient has nocturnal oesophageal reflux and extensive fixed uppper dental prostheses.How would you reduce the risk of perioperative dental damage? How can problems associated with the use of vasoconstrictors in nasal surgery be prevented? Describe the management of systemic toxicity resulting from the use of vasoconstrictors in nasal surgery.

Question 17

List the physiological effects of ECT and how they may be modified?

Question 18

As a result of a suicide attempt, a 22 yo male sustained a compound fracture of his lower tibia with extensive skin loss. Other injuries include a t12 and l1 crush fracture with no neurological sequelae. The patient suffers from schizophrenia. He is to undergo a free flap from the lower abdomen to the leg wound. What problems relating to his schizophrenia may impact on anaesthesia? Evaluate the options for postoperative analgesia. He becomes acutely agitated in the post anaesthesia care unit. Discuss the possible causes of this problem.

Question 19

Outline the anaesthetic risks specific to patients undergoing electro-convulsive therapy.

Question 20

A severely depressed 60yo man presents for electroconvulsive therapy. His history includes controlled hypertension and stable ischaemic heart disease. He is taking MAO inhibitor phenelzine for depression. What are the implications of his phenelzine therapy of relevance to GA for ECT? Describe the physiological effects of electroconvulsive therapy relevant to his anaesthetic management. Omit any considerations concerning phenelzine. Discuss your choice of induction agent for this procedure.

Question 21

Describe the clinical features of an overdose of tricyclic antidepressant.